|
Massage and Psychotherapy:
Mapping a Landscape
by Roz Carroll
|
[This paper was originally given as a talk at the AGM of Chiron Psychotherapists
in November 1998. The audience was made up of body psychotherapists and biodynamic
massage therapists and so the talk assumes a knowledge of this approach to
therapy. For psychotherapists trained at Chiron contraversy around the use
of touch in general, and biodynamic massage in particular, has been ongoing.
This is in contrast to many body psychotherapy institutions where touch is
a given; and in contrast to all the forms of psychotherapy where touch does
not play a role. ]
I am going to speak tonight of the value and richness
I find in using massage in psychotherapy. I am not going
to present a balanced argument for and against it. I
think biodynamic massage is in need of a voice to
re-articulate its potential so I am going to share my own
fascination with massage as a medium . I will also talk
about some of the ways in which the technical
difficulties it presents in a psychotherapy context can
be handled creatively and therapeutically. I am mindful
of the fact that transference itself, when first
identified as a phenomenon by Freud, was seen as an
obstacle to therapy. Nowadays, transference and
countertransference are considered the very crucible of
the transformative process.
I want to take the familiar metaphor of psychotherapy
as a journey, and suggests that when I use massage, the
client and I are exploring a landscape together . The
landscape is both the client's bodymind and our
relationship. However we chose to explore this landscape,
I am aware that the surface is not the whole story, but
the outerlayering which encompasses a deep structure. The
client and I are having an experience together, and
paradoxically, we are almost inevitably using very
different maps, and even our compasses will disagree
about which direction is north. This is the discrepancy
between the client's expectations and fantasies about
what will transpire, and my intention and interest in
using massage. The degree to which we can together become
conscious of that split, is the degree to which this
process can deserve the name of psychotherapy. The value
in using massage often lies precisely in meeting or even
exposing the feelings underlying a fantasy. The client
wants to be massaged and then in the actual encounter on
the massage table we can explore the question, "so - how
is it?"
Making conscious what is unconscious is of course a
long and involved process and I am not suggesting that
the client's splits can be worked through in massage
alone. What I am suggesting is that we can undertake a
kind of preliminary mapping. The main theme of my talk
tonight is how this mapping process can provide
co-ordinates, touchstones, which the client may still
have available later along the road, as a reference point
in the process of integration.
In a simplified version of a biodynamic model, the
individual and the environment (which includes people)
interact, and this process can be described as
psychobiological self-regulation. What biodynamic theory
does extremely well is describe how a human being manages
or organises experience anatomically and biochemically.
It offers both a model of healthy self-regulation and a
description of pathology - how conflict, pain and
experience which overwhelms the ego is encapsulated
physiologically at a cellular and autonomic level. The
dance of neurons firing, fluids rushing or congealing,
the portals of the gut surrendering to pleasure or
violently contracting, and splitting and parcelling up
the charge throughout the systems of the body. Boyesen
depicts both acute vegetative responses and the effects
of chronic internal stress, with its resulting layers of
sediment compressing weak structures with ever more rigid
defences.
One of the determining characteristics of any
self-organising system - be it a very simple organism,
such as a star fish, or a complex one such as a human
being - is the existence of feedback loops. Even with
clients who have very strongly dissociated from their
bodies, putting my hands on them can highlight in a very
immediate way an aspect of their experience, even if its
as basic as recognising that their feet are freezing
cold, or they feel numb around the thigh. My presence
with and through the touch, and my questions and
comments, offer a form of feedback. The congruence or
lack of it between the client's experience of his /her
body and my perception is already a powerful barometer of
an object relationship.
Now, there may be a very strong fantasy in the client
wanting my touch to - for example - make everything all
right, but if I hold my client with the nitty gritty of
their actual experience, their awareness of sensation, of
breathing pattern, of how present they are with me as I
touch, then the layers which begin to unfold are usually
of grief, irritation, rage, fear, disappointment, and so
on. The fantasy and the actual sensation are split off
fragments of the same experience. Of course there can be
good feelings as well - of pleasure, connection, being
held etc. Massage can help focus body awareness and I pay
a lot of attention to enhancing the client's awareness of
his/her body in the contact with me. I believe that
body-awareness - the cohering of sense perceptions - is a
fundamental building block for self-awareness, and
ultimately, interpersonal and intrapsychic
awareness.
Biodynamic massage offers tools for clearing the
superficial debris from the energetic field in order to
focus and amplify sensory detail of an impulse or
movement of energy which may be barely discernible under
layers of defence. It is a form of feedback, and can help
the client differentiate and separate out different parts
so they can have a sense of themselves and say things
like - I don't feel connected to my legs, there's a lot
of heat around my shoulders, my arms feel vulnerable, my
head is buzzing.
The limitation of the biodynamic model, however, is
that the individual as a self-organising system is
conceived of as uncontaminated by internal objects. But
we can add internal objects as a third factor in the
loop. By internal object I mean a mental representation -
usually unconscious - of an external figure of
significance. It is in the nature of internal objects
that they are going to be projected into or onto any
available space. They can be externalised - projected
onto a person, event or thing. Or internalised,
introjected into the body. In using massage, there is the
possibility of working with both aspects.
Internal objects can be projected onto the act of
massage itself as a fantasy about what it implies. For
example - massage is the laying-on of hands, massage is a
theatre for cathartic performance, the massage table is
an operating table. Such fantasies are usually
unconscious but can be accessed through the client's
associations to what is happening, and through the
countertransference. The scenario, for which the massage
table is a prop, usually implicates the role of the
therapist. One client found herself thinking of a nursery
rhyme, "Ha, ha, ha, he, he, he. I'm the gingerbread man -
you can't catch me!" So we explored that and she realised
that underneath the mischievous sense of hiding and
running was the fear of being moulded and controlled by
me as the baker.
The transference may be directly or indirectly
experienced by the client. With one client, a young
professional woman whom I shall call Elizabeth, I have
explored in detail the theme of torture via her
experience of her body in the transference with me. She
originally came to me for massage, although we soon
changed to a psychotherapy contract, and at the beginning
she found it hard to identify and name sensation. Then,
in our twelfth session I was doing some very modified
deep draining - there was peristalsis and some deep
breaths, but I had the sense of invading her. And I said,
"even though I can't see it, I feel as though you're
trembling." She said there was a pain shooting up to her
head and she had an image of a flashing light. And so I
asked, "how far would you let me go before you said
stop?" and she said a bit shakily, "you've got my best
interests at heart". To which I replied, "that's the
theory, but your body suggests otherwise". I also
connected this interaction with me to what was happening
in her life with a friend who she was having sex with
despite the fact that it wasn't what she wanted.
A few sessions later, when I had one hand on her
shoulder and another on her elbow, she became aware of
feeling pinned down, and having a panicky impulse to push
me out of the way. She had the image of a torture chamber
and me as her mother intent on restricting or punishing
any feeling or sensation in the body. We have pursued the
ramifications of this both on and off the massage table.
She has identified the feeling of torture with being
attached to a mother whom she hates but is unable to
separate from. Clearly massage is associated on one level
with violent repression. The flip side of it is a
powerful fantasy of me as a psychic surgeon who could
operate on her - to remove her mother, who is imagined as
inside her womb. There came a point about six months ago
when we stopped massage, as I said to her, "why do you
want to keep torturing yourself?" and we began to look at
the desperation which pushed her to keep re-enacting her
conflict. The experience of torture often manifested for
Elizabeth as an image of cruelty with lines from a love
song echoing in her head as a kind of mocking
accompaniment. These discrepancies between image and
tone, sensation and fantasy, the client's words and their
body signals are extremely important for understanding
the transference and levering it up into consciousness.
These splits are not just a signpost to the therapist,
but play a crucial role in helping the client experience
incongruence and conflict between parts of
themselves.
I want to talk now very briefly about introjection
and what I am calling the somatic metaphor. A somatic
metaphor is an energetic pattern in the body which both
symbolises and expresses an unconscious conflict. It can
be an illness, or a set of symptoms, pain, tension etc.
or just a fleeting energetic self-perception. It can be
acute - a metaphor of the moment; or chronic, a metaphor
which permeates the clients' life. For example Elizabeth
would experience a violent spasm of her abdominal muscles
when she was getting a feeling that her mother wouldn't
approve of. The spasm is the introjected mother putting
the boot in. The metaphor is the client's attempt to
comprehend, or reconcile the conflict between internal
objects, and to maintain stability in existing
relationships. It represents something outside awareness,
and it is only through reflection, or the intrusion into
consciousness of pain, limitation, or indeed a diagnosis
of illness that it begins to be known.
Client or therapist may first glimpse the metaphor
through noticing a phrase like, "I haven't got a leg to
stand on", "my heart's not in it", or through focusing on
sensory detail in the body. For example, one client
described her eyes "as standing in front of my heart to
protect it". The meaning in terms of object relations may
need some elucidation. In the last example - the sense of
the eyes standing guard is powerful, and invites
questions such as, who does the heart represent? who or
what does it have to be protected from? Sometimes the
metaphor may not explicitly include the body. For
example, with one client I noticed that she used the
phrase, "all or nothing" in reference to what she wanted
in a relationship. This translated in the massage into a
demand for total fulfilment of all needs. The fantasy in
the demand actually masked the anguish of being with her
frustration. As I massaged her neck, she got in touch
with an animal sense of her jaw, with a deep desire to
bite and suck, whilst also hating me for not doing
more.
Naturally, this exploration has many dimensions. I
may make use of my structural knowledge of the body, and
my understanding of early development, and of character,
in quite a technical way to extend the mapping process.
Let me give an example : "I don't know which way to
turn". The client may use this phrase as they are
talking, or may be it will occur to me as I am with them.
Perhaps I notice the client's discomfort or restlessness
on the table, as they turn their head this way, and that.
I may put my hands on their back. The client becomes
aware of tension in and around the spine. As we stay with
it, it may become a sense of turmoil, of trying to
escape, of contorting this way and that. At this point it
can be tempting for the client to just writhe around and
attempt to get rid of that unbearable feeling of deep
tension. I would probably encourage the client to slow
this down a bit so we can both get a feel for exactly how
the spine is twisting.
is it primarily led by the head?
is it initiated from the neck?
how are the shoulders/ elbows involved?
is the back flexing and extending?
or is it moving laterally?
or is it a combination?
This is where experience, the capacity to contain the
client, and the ability to focus on sensory detail is
crucial. There can be many layers to a pattern, and
sometimes clients present quite a tangle of impulses and
defences. The therapist needs to hold that chaos, and
have the clarity to unpick it. So, lets go back to the
client twisting on the table. Considering the client's
movements and my own countertransference response, I
would be wondering:
are these movements in the back related to a birth
process ? (Activated birth reflexes always have a
symbolic significance which relates to the present. I
need to consider whether I am standing in for a very
early part object, for example, a suffocating womb or an
unyielding cervix.)
or is it to do with rooting reflex ? (The rooting
reflex is a primitive reflex which orients the baby
towards the breast. Nonreinforced, unintegrated,
extinguished and overstimulated reflexes are all potent
carriers of relationship dynamics. For example, in the
Robertson video of the little boy John who is left in
care whilst his mother goes into hospital to have a baby,
we see his progressive emotional deterioration. When she
returns, he turns his head away from her, exhibiting a
sort of 'anti-rooting' reflex - what in Jane Austen's day
they used to call "cutting someone dead".)
or perhaps there's a sense that someone's on the
client's back?
or are they just recoiling from their own instinctual
energy? (hysterical arch)
I am very interested in space and dimension, the
vector of movement of energy. Is the object coming from
the side? or from above, or up from below? This
preliminary mapping is followed through in my process
with questions such as escape from what object? is this
turning away from the bad breast? or from a tyrannical
father? or is it precisely that the client is caught
between the two? is the father on the back and the mother
in the face?
How and when I would explore this with the client
verbally, how much I would relate directly to our
relationship, would depend completely on where the client
was with the process, and in the relationship, and the
kind of vocabulary and concepts they have for thinking
about it. It varies enormously. Some clients are very
sophisticated and can readily reflect on quite intense,
primitive behaviour. With other clients I would say very
little, but I would hold the information in my awareness.
The most primitive level of object relating embodied in
the system may be just glimpsed at this stage, but its
there as a marker that both the client and I can refer
to. Perhaps the client finds then that they are not
wanting massage, and we can look at how they experience
that or recognise it. Often its deeply unconscious -
something has been touched and the client will want to
find a different level to interact with me.
In using massage I am working on different levels
simultaneously and moving through different modes all the
time. Reflecting back and forth, noticing vegetative
changes, and allowing my hands the possibility of free
associating and, at the same time, finding ways to
interact with the client verbally, or not. The more I
work with massage, the more I trust my impulses to bring
forth elements which may be buried in the relationship.
Sometimes the techniques are just a way of having a
conversation. Often what I 'do' is minimal because what
I'm interested in is the encounter. If I am very active,
that in itself is a countertransference response. For
example, with a client who is very restless and defends
intensely against relaxation, I recently did a very
physically vigorous work out - vehemently pushing and
rocking and stretching and kneading. I was aware that I
was allowing her violent frustration to manifest (in a
modulated way!) externally through me 'doing' it back to
her. It enabled her to laugh from her belly and feel the
relief - for a short while - of not having to contain it,
and thus to know, experientially, the strain of having
held it. I didn't say much during the session, but at the
end commented that what I had done was more congruent
with how she felt inside .
Biodynamic massage is sophisticated enough to address
both the actual physicality of the body and its energetic
reality. The energetic or subtle body is the connecting
link between the physical body and the body as a symbolic
or fantasy space. If I can relate to that fantasy space
with my language as well as my hands, if I can touch
something and help the client name it, then I believe
there is a process of integration happening, or at least
an attention to the dis-integration.
I want to keep the definition of somatic metaphor
very broad, but in using it as a framework, I take into
account three key criteria. Firstly: it needs to be
recognisable as a set of feelings and sensations
Secondly: it has to have a meaning that can be captured
easily in a short phrase. Thirdly it has to give form or
sense to a relationship which exists in the past and the
present, internal and external. In other words, it has to
be embodied, embedded in language, and encompassing a
dynamic relationship.
In my experience though the client may suffer with
the limitations illness and pain impose on their life,
until they have an embodied sense of a dynamic, they
can't really make use of insight. Ultimately the somatic
metaphor needs to be experienced by the client on all
three levels - sensation, symbol and relationship. For it
to be recognised and integrated by the ego can, of
course, take years. Massage can contribute to mapping
major landmarks but it does not constitute a complete
process.
What I hope I have been able to evoke for you tonight
is how I think massage can be of value in making the
somatic metaphor more graphic, more readily identifiable,
and more accessible. I want to conclude with two
contrasting metaphors for my use of massage in
psychotherapy. One is of massage as a vehicle, a means of
exploring a landscape. The other is of an animal tracking
a scent, nose close to the ground...........
I will leave you with this paradox.
Bibliography
Abram, David The Spell of the Sensuous: Perception
and Language in a more-than-human World (Vintage,New
York, 1997)
Bainbridge Cohen, Bonnie Sensing, Feeling and Action
(Contact Press, 1993)
Bollas, Christopher The Shadow of the Object
Boyesen, G., 'Theory of Neurosis' Journal of
Biodynamic Psychology, No.1 1980
Boyesen, G., 'The Dynamics of Psychosomatics' Journal
of Biodynamic Psychology, No. 3 1982
Boyesen, M.L 'Psychoperistalsis: the abdominal
discharge of nervous tension' Collected Papers of
Biodynamic Psychology, Vols I& II, 1980
Capra, Fritjof The Web of Life: A New Scientific
Understanding of Living Systems (Anchor, New York,
1986)
Broom, Brian Somatic Illness: The Patient's Other
Story (Free Association, 1997)
Damasio, Antonio R., Descartes' Error : Emotion,
Reason and the Human Brain (Putnam,.New York, 1994)
Gomez, Lavinia An Introduction to Object Relations
(Free Association, London, 1997)
Hartley, Linda Wisdom of the Body Moving: An
Introduction to Body-Mind Centering (North Atlantic,
Berkley, 1994)
Lakoff, George and Johnson, Mark Metaphors We Live By
(University of Chicago, 1980)
Moore, Thomas (ed) A Blue Fire: The Essential James
Hillman (Routledge, London, 1990)
McDougall, Joyce Theatres of the Body: a
psychoanalytic approach to psychosomatic illness (Free
Association, London, 1989)
Rycroft, Charles, A Critical Dictionary of
Psychoanalysis (Penguin, Harmondsworth, 1968)
Samuels, Andrew The Plural Psyche (Routledge,
1989)
Schwartz-Salant ed. The Body in Analysis (Chiron
Clinical Series, 1986)
Woodman, Marion Addiction to Perfection (Inner City,
1982)
Email Roz at
thinkbody@lineone.net